‘Critical Condition:’ How to Save American Health Care?
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Welcome to Code WACK!, your podcast on America’s broken healthcare system and how Medicare for All could help. I’m your host, Brenda Gazzar.
Why is America’s healthcare system in critical condition — and what can save it? We spoke to Dr. Abdul El-Sayed, a physician, politician, best-selling author and podcast host about his fascinating life and his new book “Medicare for All: A Citizen’s Guide.” This is the first of a two-part series.
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Welcome to Code WACK!, Dr. El-Sayed.
El-Sayed: Thank you so much for having me. I’m excited to be here with you.
Q: If you can tell us a little bit about your background. You started in medicine and public health, and then switched to politics even running for Governor of Michigan in 2018. What motivated you to make this switch?
Dr. El-Sayed: Yeah, I grew up in this really interesting, um, and uncommon household. My father is an immigrant from Alexandria, Egypt, and my stepmom who raised me is a daughter of the American Revolution, and so I sort of grew up between different worlds with a bit of a foot in each of them, and most summers, I would get on an airplane — sometimes before school was even out — to go to Alexandria where I’d get to spend most of my time with the wisest, most intelligent person I have yet to meet in my life, who was my grandmother. She never got to go to school and her life was an exercise in contrasts that were really helpful and morally clarifying for me. The first is the fact that she had eight children to whom she gave birth, two of whom died before the age of one. She had a personal infant mortality rate of 25%.
In those trips, you know, I could see the difference in life opportunities between people and my grandmother would always accentuate that. She would point to one of my cousins and say that one’s smarter than you. She would point to another one and say, that one’s taller and better looking and point to a third one and say that one’s more athletic, and point to a fourth one and say that one’s nicer and kinder to the point where I didn’t really think I had anything going for me and she said no, you have the best of all, you’ve got opportunities and the thing is in those 15 hour trips I traveled about 10 years difference in life expectancy and the craziest part of that is that I didn’t have to go 15 hours, I could go 15 minutes.
And for me, that choice to pursue a career in medicine was about trying to rectify the clear differences that our society has in who gets to live a long healthy life, and I thought that a career in medicine was going to be the way that I could have an impact on that, and it became really clear that rather than being a way that we solve those problems, in fact, the system that we practice in in the United States is a part of recreating them.
And so I left clinical medicine for public health, and then ultimately left to rebuild the health department in the city of Detroit, and in that moment, my job was to rebuild that department in that city that was such a contrast to where I got to grow up. And in doing that came front and center with the politics that I think allocates resources too often back to those who have and extracts from those who don’t, and ultimately seeing that, seeing the way that that had shut down the health department, defunded public health in America’s largest majority black poorest city, and then watching the same thing poison 9,000 kids in Flint and then watch Donald Trump get elected, that’s when I decided to run for office.
Q: Oh wow. Interesting. How did you come to support and become an advocate for Medicare for All?
Dr. El-Sayed: You know through medical school, frankly you know, even in college, I had become really interested in the question of why we’re the only high-income country in the world that doesn’t provide universal health coverage. I was in grad school when the (Affordable Care Act) debates were taking place and came to appreciate the kind of politics that exist around health care, and the ways that those who have controlled the healthcare industry for their profits, the health insurance industry, the pharmaceutical industry, the hospital corporations, the ways that they shaped the debate, and the ways that they viciously opposed even reforms that protected their profits, and the whole time, those of us who were, you know, at that point, relatively naive to the system of politics kept asking: Well, if we’re going to reform health care, why don’t we just fix the problem rather than tinker around the edges?
And I think a lot of people came out of that ACA fight thinking well, this is the reason you can’t get health care reform. And I think a lot of us who were a bit younger, or a bit more idealistic came out of it saying, well, this is why you’ve got to go all the way, right? These folks have way too much power and that power dictates who gets health care and who doesn’t in our country in profound, inequitable ways, and that sort of set me on that path and when I decided to run, I knew that I was going to run on a state-level version of Medicare for All. And, you know, after I didn’t win, the question for me was alright, how do I leverage both the insights I have in the healthcare system, and the knowledge I have of politics, to articulate you know soup to nuts the ways in which our healthcare system fails people and the ways in which Medicare for All would solve that.
Q: Um-hmm, great. So your best-selling book Medicare for All: A Citizen’s Guide argues that America’s healthcare system is in critical condition? What do you mean by that?
Dr. El-Sayed: Well, I mean, you don’t have to look much further than a year to understand exactly how we faced the worst pandemic in over a century. And rather than stand up to that pandemic, our healthcare system got as close to collapse as possible. We watched as 47 hospitals went bankrupt or were shut down completely in the midst of a global pandemic. Fifteen million people lost their health insurance, lost their health coverage in the midst of a pandemic. Nurses and doctors and hospital employees having to wear garbage bags while caring for the sick and dying inside of our hospitals in the richest, most powerful country in the world.
Meanwhile, the insurance industry made more in 2020 than it ever has. They spent $151 million across 845 lobbyists to make sure that politicians were as blind as possible to their failures, $120 million in the last cycle alone electioneering giving money to politicians to maintain the status quo. That to me is as much of an indictment as you need to know but it’s not just the pandemic, right? It’s not just these, these moments of extremis that demonstrate how broken our system is because the normal, we keep wanting to go back to as normal where 10% of Americans didn’t have health care at all.
And even for those who had it, they faced a deductible in the thousands of dollars, the median family of four earned $69,000 in a year, and their deductible is about $3,600. That’s more than a biweekly paycheck. I don’t know how many families earning $70,000 a year can go without a paycheck because their insurance requires it. That’s above and beyond what they’ve already paid, the premiums that they’ve already paid. So, this system is fast becoming unsustainable for people, even outside of pandemic conditions. It fails us in the moments when we need it most and for that reason it is in critical condition.
Q: Thank you. In the book, you tell the story of Lisa Cardillo and her husband. Can you briefly tell us about them and the significance of their story for American health care?
Dr. El-Sayed: Yeah. Lisa was 36-years old when she started feeling the symptoms of a potentially catastrophic heart attack, a rare form that affects younger women like her. The crazy thing is that this was three years after her husband had had a brain tumor. And when he went through his brain cancer, she had learned exactly what it means to have quote-on-quote health insurance in this country after spending hours upon hours fighting for the health care that she thought she had already paid for. Friends and family pitching GoFundMe’s and fundraisers to make sure that they could pay their deductible, and then crisis hit their family again and they were in a situation where they were trying to manage the costs of care for her and now for her husband who continues to have to get an MRI every three months and those are extremely expensive.
And so, you know, she was the kind of person who in the past, our healthcare debate wouldn’t have centered on, right? Because in the past when we were talking about health care, it was about providing health care for low-income people, and frankly that should be enough, but it hasn’t been. But Lisa is insured through her husband’s insurer. She is supposed to be the kind of person who is taken care of. In fact, the operative term in the word insurance is sure. And there’s nothing sure about her experience with insurance and so, given what she went through, it’s very clear that a lot of folks think that their insurance is going to be there for them when in fact it’s not.
And this is sort of the magic trick, the evil bait and switch that the insurance industry perpetuates on people. You think it’s going to be there for you because you’ve been paying through your nose every two weeks or every month. And when you need it most, it’s not there for you and you don’t know it but you signed away sometimes tens of thousands of dollars in deductibles, thinking that, of course, that wasn’t going to strike you. And so, you know her experience really is emblematic of the failures of our current system.
Q: Hmmm. And what happened with her ultimately?
Dr. El-Sayed: Well, thankfully she lived and you know she continues to have to haggle and fight and beg and plead with her insurance bureaucracy and you know, and she has become an advocate for universal health care in the form of Medicare for All because she does not believe that anybody should have to go through what she and her husband Dominic have experienced.
Thank you Dr. El-Sayed.
Find more Code WACK! episodes on ProgressiveVoices.com and on the PV App. You can also subscribe to Code WACK! wherever you find your podcasts. This podcast is powered by HEAL California, uplifting the voices of those fighting for health care reform around the country. I’m Brenda Gazzar.
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